Emblem Health to Implement Automated Provider Data Updates via CAQH
02/10/2025
Emblem Health to Implement Automated Provider Data Updates via CAQH
Starting Dec. 20, 2024, Emblem Health streamlined provider directory updates by implementing daily file feeds from CAQH. This change ensures that demographic information for non-delegated professional providers is updated automatically based on their NPI and tax ID combination.
What This Means for Providers
Providers should now make all directory updates directly within the CAQH application. Any changes made in Emblem Health’s provider portal will be overwritten by CAQH data. To ensure accuracy, providers are encouraged to log into the Emblem Health provider portal at Emblem Health Provider Sign-In (https://www.emblemhealth.com/providers/resources/provider-sign-in) to review their directory profiles and payment information before making necessary updates in CAQH.
Exceptions to CAQH Updates
Some provider groups and data types require alternative update methods:
- Delegated Credentialing Organizations: If your organization has a delegated credentialing relationship with Emblem Health (as listed on their Join Our Networks web page), submit changes via the established dataset process.
- Hospital-Based & Non-Credentialed Providers: All updates must be sent directly to Emblem Health.
- Facilities: All changes must be sent directly to Emblem Health.
- Primary Care Providers: Updates to open or close a primary care provider’s panel should be sent directly to Emblem Health.
- Doulas: Emblem Health doulas needing to update their contact information should email medicaidproduct@emblemhealth.com.
Next Steps for Providers
To avoid potential disruptions, providers should review their directory information and confirm all necessary updates are made within CAQH before the implementation date. Staying proactive will help ensure accurate information is maintained in Emblem Health’s provider directory.
For more information or assistance, providers should visit the Emblem Health provider portal or contact Emblem Health directly.